Blood Tests

Blood and Bone Marrow tests
Blood tests are integral to the diagnosis and management of WM by your doctor. In conjunction with bone marrow samples, physical examination and CT scans they have three main functions. Firstly, they let doctors diagnose WM and distinguish it from other related Non-Hodgkin Lymphomas (and in particular Myeloma.) Secondly, they indicate possible treatment options (including do nothing or Watch and Wait) and thirdly they may give the specialist an idea of your prognosis - that is the likely long term progress of your disease.

Many patients keep a record of their key results (in a spreadsheet if IT savvy), which enables them to match how they feel with changes in the blood chemistry over time - such as linking Haemoglobin, (Hb) and tiredness due to anaemia- these in turn reflecting changes in the bone marrow. Most doctors are more than happy to let you have a copy of your results and it will become common in future to be able to access your tests online, as is common in the USA.
It’s usual to have a blood test shortly before or on the day of each meeting with your consultant, but some results, such as IgM and serum viscosity (if used), may take a week or so to complete.
Blood test results vary marginally from lab to lab and uncertainties in the more difficult measurements such as IgM (Immunoglobulin M) make it unwise to draw conclusions from small changes- usually steady changes over time are more significant. Fortunately WM being generally an indolent (slow moving) disease usually gives you and your doctor time to think.

The decision to treat WM by your specialist is usually taken on the basis of symptoms, assisted by your blood and bone marrow results, not on results alone. It’s clear that people react very differently to their changing blood chemistry. For instance, with IgM paraprotein some have no symptoms at 50g/l others have significant symptoms at 20 g/l, and the measurement itself seems to have only a general relationship to what is happening in the bone marrow. One of the many mysteries of WM!
If you would like to go into more details there is a detailed guide by Dr Guy Sherwood et al that can be downloaded on the IWMF website at IWMF medical tests. Take care to look at the units of measurement which may differ between UK and USA- particularly Immunoglobulins, where USA measures are 100 times UK/EU.

Reference ranges are usually given for each measurement to allow you to compare with norms at your hospital. These can vary between men and women, between countries and even slightly between hospitals. Out of range measurements are usually flagged up (H or L) on your report. Only the most useful and common measurements are described here. If you are to undergo chemotherapy or stem cell transplant then other tests such as those indicating kidney, heart, liver or lung function may become important, as the body has to have the capacity to remove waste products of chemotherapy.

Here is a specimen of the basic blood count. References ranges are for a male WM patient. He has had WM for 12 years and underwent a stem cell transplant 3.5 years ago at UCLH. Note right side may not all be visible on small screens.

The reference range above is to the right and flags at the extreme right. In this case Lymphocytes and White cell counts are high as the patient has a temporary sinus infection.
Normally keeping track of changes in White cell, Haemoglobin, Platelets and IgM/Paraprotein (below) will give a reasonable idea of how your disease is progressing over time. Note that most hospitals now report Haemoglobin in g/l, i.e. 10 times larger. The reading here in new units would thus be 158 g/l.

Immunoglobulins are shown above. Immunoglobulin M - the key marker of WM is just in the normal range as the patient has had high dose chemotherapy and is in good remission. In severe cases, before treatment it could be as high as 60 g/l. This total IgM reading includes both normalIgM and abnormal paraprotein. A separate test below reports the abnormal paraprotein, which in non-WM patients should be close to 0. Here it is 3, showing that the patient still has WM, but the disease is at a very low level.
Clinically, if IgM paraprotein is over 30 and the patient has symptoms, this is usually an indicator to the clinician to consider starting treatment. Note: In the USA, IgM is reported in mg/dl, giving readings 100 times UK/EU results.

Beta2-microglobulin test results are shown. These are not always done, but are an indirect indicator of so-called 'tumour burden'. Here they are just in normal range, as would be expected in a good remission.

The last three results relate to a trial using a newer assay method to more accurately measure paraproteins. If you are interested and technically minded you can find out more at the Binding Site

Finally, it's a good idea to keep a record of your key test results in a simple spreadsheet (most hospital store all your results, so ask for a your printout to study at leisure). This means you can relate how you feel to what is happening to your blood chemistry, and may make you feel a little more in control. This example below is a little depressing! It shows the last two two years at the end of a remission of 5 years from R-CHP chemotherapy. The IgM readings slowly increase (although not consistently) and white and particularly red counts fall. CRP stands for C reactive Protein, which relates to inflammation or infection- most likely related to weakening of the immune system. In Nov/Dec a decision was taken (in conjunction with extreme tiredness and 70% infiltration of WM cells in the bone marrow) to start ESHAP chemotherapy - the 'conditioning' before an autologous stem cell transplant some 8 months later.

Patients are commonly genetically tested at diagnosis (using bone marrow and/or saliva) for the presence of the common WM mutations MYD88 and CXCR4. This currently does not impact on treatment choices, but the effectiveness new generation of inhibitors such as Ibrutinib may depend on genetic make up, so this will become increasingly important.